MEDICARE: ANDREA KEMP PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP7854	AZ

General Provider Information

NPI Number	:	1265812135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA KEMP PMHNP

Provider Business Mailing Address
First Line	:	3450 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2331
Country	:	US
Telephone Number	:	602-257-9339
Fax Number	:	602-265-8533

Provider Business Practice Location Address
First Line	:	1424 S 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3902
Country	:	US
Telephone Number	:	602-257-1558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	12/13/2022

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